Provider Demographics
NPI:1285499186
Name:LAMB, STEPHANIE (MBA, MSW, CSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LAMB
Suffix:
Gender:F
Credentials:MBA, MSW, CSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LAMB
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MBA, MSW, CSW
Mailing Address - Street 1:PO BOX 77053
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-7053
Mailing Address - Country:US
Mailing Address - Phone:318-570-5400
Mailing Address - Fax:318-570-5403
Practice Address - Street 1:2101 TOWER DR STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5045
Practice Address - Country:US
Practice Address - Phone:318-570-5400
Practice Address - Fax:318-570-5403
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
LA17142104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor